| NPI | 1639459662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005861) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 0013354) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2025-06-23 |